Lancet: Carotid bruits detection can help identify cardiovascular risk

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Auscultation for carotid bruits in patients at risk for heart disease could help select those who might benefit the most from an aggressive modification strategy for cardiovascular risk, according to a meta-analysis in the May 10 issue of the Lancet.

Christopher A. Pickett, MD, from the department of medicine at Walter Reed Army Medical Center in Washington D.C., and colleagues sought to investigate whether a carotid bruit predicts MI and cardiovascular death.

The researchers searched Medline (1966 to August 2007) and Embase (1974 to August 2007) with the terms carotid and bruit. They extracted the outcome variables in duplicate and included the rate of MI and cardiovascular mortality. The investigators pooled the data with a random effects model.

Of the 22 articles included, Pickett and colleagues found that 20 (91 percent) used prospective cohorts. Their analysis included 17,295 patients with 62,413.5 patient-years of follow-up, with a median sample size of 273 patients followed up for four years.

The rate of MI in patients with carotid bruits was 3.69 per 100 patient-years (eight studies) compared with 1.86 per 100 patient-years in those without bruits (two studies), according to the authors.

The researchers found that the yearly rates of cardiovascular death were also higher in patients with bruits (16 studies) than in those without (four studies) (2.85 per 100 patient-years vs. 1.11 per 100 patient-years). In the four trials in which direct comparisons of patients with and without bruits were possible, the odds ratio for MI was 2.15 and for cardiovascular death 2.27.

The authors noted that their “study has shown that the presence of a carotid bruit significantly increased the likelihood of a cardiovascular death or MI.”

“Since auscultation of the carotid is a swift and inexpensive test, it should be used in every patient who might be at risk for coronary heart disease to aid the clinician in assessment of cardiac risk,” Pickett and colleagues concluded.